March 26, 2021

A patient fell from a train platform and was struck by a slow moving train and was then electrocuted. He was worked up at another Level One trauma center and transferred to us for treatment of 3rd and 4th degree burns (but only 5%). His traumatic injuries gave him an ISS of 14 (spleen lac, Tspine fx, HTX, rib fx’s). His burn injury is an ISS of 4. He was transferred here for burn BUT admitted to trauma with a burn consult and a few days later transferred to burn service only. There were no other interventions by the trauma service other than managing a chest tube and ordering consulting services. I understand our manual states to use the highest ISS when the there is more than one mechanism but would you deviate in the case of a transfer in from another trauma center? Burn mech and admit first? Or Trauma mech and admit first?

We recommend to always record the mechanism that caused the most severe injuries first. In this situation, we recommend the mechanism code for the strike by train as the primary and the mechanism for the electrocution as secondary based on the information provided.

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